Psychoanalysis and Couple Therapy

Psychoanalysis and Couple Therapy

Psychoanalysis seeks the sources of human motivation in the patient's interior life and past. It leaves to the patient responsibility for behavior in the present. Couple and family therapies focus on current behavior and leave responsibility for inner life and the past to the patients.

These statements, while not incorrect, are mere caricatures of the two approaches. At best, they are outmoded presentations of the most extreme positions of opposing and apparently incompatible schools.

I believe both approaches are not only compatible, but necessary, to clinical work and thought. As long ago as 1974, this issue was discussed by John F. McDermott, M.D., and Walter F. Char, M.D., in the article, "The Undeclared War Between Child and Family Therapy." Currently, couple therapists are paying more attention to inner life and psychoanalysts are seeing couples.

Analysts, aware of the need to remain loyal to the interests of their individual patients, worry they will take sides when working with a couple in conflict. They fear that a hidden bias toward one partner will destroy their objectivity. Couple therapists, aware of the complexity of dealing with immediate problems of communication, misunderstanding and destructive behavior, fear getting trapped in the endless byroads of the unconscious, thereby evading difficult issues in the present.

These errors are possible, but maturation of both psychoanalysis and couple therapy make them less likely. Psychoanalysis evolved from a practice in which the ideal analyst was inscrutable, listening and providing interpretations intended to correct distortions in the patient's inner life. Self-knowledge, detachment, objectivity and intellect were the most highly valued qualities in the analyst. Now, the analyst's capacity for empathy and active emotional involvement with patients are seen as essential to the therapeutic process. Analysis itself is a real-life experience. With this shift in emphasis, the people in the patient's life become important for their own qualities, and not just as objects of the patient's drives or projections.

In contrast to psychoanalysis, which explores the lasting effects of early experience, family therapy began by focusing on here-and-now interactions. Clarifying communication and rearranging roles were found to be powerful tools. Couple and family therapists have continued to use these interventions, as well as assigning tasks and rituals to patients between appointments. However, while dealing with families in which there had been severe trauma and abuse, it became clear that the damage from the past needed to be clarified, elaborated on and confronted in the present. This has led to a re-examination of the adequacy of a present-time approach as the exclusive therapeutic modality.

Transference

When sitting with two people in conflict, neutrality is neither possible nor desirable; one's sympathy changes from time to time. It is inhibiting to strive to remain evenhanded at all times, and it is constricting to try to keep one's leanings completely hidden. It is essential in individual treatment for the patient to have the conviction that the therapist's first loyalty is to him or her. Thus, it might seem destructive in couple treatment to say at one moment that you find yourself on the side of one of the partners. This is not dangerous, however, if it is clear from the start that your sympathies will shift.

There needs to be a continuous dynamic shifting of alliances. If one's sympathy remains fixed with only one partner, the treatment is unworkable. Focusing, for a time, exclusively on one member of a couple permits the exploration of that person's experiences and conflicts. During that time, the other partner is audience to the dialogue. Much can be learned when listening to a third party investigate a troubling area with one's partner.

Couple and family therapy has enlarged our understanding of transference phenomena. Transference, a phenomenon first described as an unconscious aspect of the relationship of analysand to analyst, also is present in nonanalytic settings. The need to rethink transference became clear when patients were concurrently in couple or family therapy and in individual treatment. Were the transferences similar, or different, in the different modalities? Did husband and wife have similar transferences to their shared therapist? And what about countertransference? Could it be negative to the husband and positive to the wife? Could it be negative to the couple, but positive to each individual? Understanding these transferences can be an important part of understanding the dynamics of a couple.

My colleagues and I invented the term transference field to describe this extension of transference beyond the analyst-analysand duo (Ehrlich et al., 1996). The term extends the concept of transference to include all the unconscious forces at play among a group of affectively involved people. These forces may be positive or negative, transient or enduring. In a treatment situation, this field also includes people who are not directly involved in any of the therapies. There are transferential aspects to all the relationships, whether patient-to-therapist, therapist-to-patient, patient-to-patient or therapist-to-therapist.